Department of Medicine, MetroWest Medical Center, Framingham, MA, USA.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
J Cachexia Sarcopenia Muscle. 2024 Apr;15(2):671-680. doi: 10.1002/jcsm.13417. Epub 2024 Jan 14.
The risk of heart failure (HF) in underweight diabetes mellitus (DM) patients has rarely been studied. We conducted a cohort study to investigate the association between underweight (BMI < 18.5 kg/m) and BMI change over time and the risk of HF in patients with type 2 DM.
We utilized the health screening data from the National Health Insurance Service and the Korean National Health Screening database from 2009 to 2012, with follow-up until December 2018. Participants with DM were categorized into four groups based on their BMI at 4 years before study inclusion and BMI at the study entry: (1) Always Normal Weight (BMI at 4 years ago/BMI at study entry ≥18.5/≥18.5 kg/m, reference group); (2) Transitioned to Underweight (≥18.5/<18.5 kg/m); (3) Transitioned to Normal Weight (<18.5/≥18.5 kg/m) and (4) Always Underweight (<18.5/<18.5 kg/m). Participants were followed until the development of HF or at the end of the follow-up. Initial screening data included participants with DM who had the health screening during the study period (n = 2,746,079). Participants aged <20 years (n = 390), those who did not undergo health examination 4 years prior (n = 1,306,520), and those with missing data (n = 77,410) were excluded. Participants diagnosed with HF before study participation (n = 81,645) and within 1 year of study enrolment (n = 11,731) were excluded. After applying exclusion criteria, 1,268,383 participants were finally included in the analysis. The primary outcome was the development of HF. We employed Cox proportional hazards models, adjusting for various confounding factors, to assess the risk of developing HF.
Median follow-up duration was 6.88 years and men were 63.16%. The mean ages of each groups were as follows: Always Normal Weight (57.92 ± 11.64 years), Transitioned to Underweight (62 ± 13.5 years), Transitioned to Normal Weight (56.6 ± 15.29 years) and Always Underweight (57.76 ± 15.35 years). In comparison with the Always Normal Weight group (n = 1,245,381, HF = 76,360), Transitioned to Underweight group (≥18.5/<18.5 kg/m, n = 9304, HF = 880, adjusted Hazard Ratio (aHR)1.389, 95% confidence interval (CI) 1.3-1.485) or Transitioned to Normal Weight (<18.5/≥18.5 kg/m, n = 6024, HF = 478, aHR 1.385, 95% CI 1.266-1.515) exhibited an increased risk of HF. The highest risk was observed in the Always Underweight group (<18.5/<18.5 kg/m, n = 7674, HF = 665, aHR 1.612, 95% CI 1.493-1.740).
Underweight was significantly associated with the risk of HF in the DM population. Active surveillance for HF in an underweight DM population is needed.
体重过轻的糖尿病（DM）患者发生心力衰竭（HF）的风险很少被研究。我们进行了一项队列研究，旨在调查 2 型糖尿病患者的体重过轻（BMI<18.5kg/m²）和 BMI 随时间变化与 HF 风险之间的关系。
我们利用了 2009 年至 2012 年国家健康保险服务和韩国国家健康筛查数据库中的健康筛查数据，随访至 2018 年 12 月。根据患者在研究纳入前 4 年的 BMI 和研究入组时的 BMI，将 DM 患者分为四组：（1）始终正常体重组（BMI 在 4 年前/BMI 在研究入组时≥18.5/≥18.5kg/m²，参考组）；（2）体重过轻组（≥18.5/<18.5kg/m²）；（3）体重正常组（<18.5/≥18.5kg/m²）；（4）始终体重过轻组（<18.5/<18.5kg/m²）。参与者在随访期间被随访至 HF 发生或随访结束。初始筛查数据包括在研究期间接受健康检查的 DM 患者（n=2746079）。排除年龄<20 岁的参与者（n=390）、未在研究前 4 年接受健康检查的参与者（n=1306520）以及缺失数据的参与者（n=77410）。排除在研究前患有 HF 的参与者（n=81645）和在研究入组后 1 年内患有 HF 的参与者（n=11731）。在应用排除标准后，最终有 1268383 名参与者纳入分析。主要结局是 HF 的发生。我们采用 Cox 比例风险模型，调整各种混杂因素，评估发生 HF 的风险。
中位随访时间为 6.88 年，男性占 63.16%。各组的平均年龄如下：始终正常体重组（57.92±11.64 岁）、体重过轻组（62±13.5 岁）、体重正常组（56.6±15.29 岁）和始终体重过轻组（57.76±15.35 岁）。与始终正常体重组（n=1245381，HF=76360）相比，体重过轻组（≥18.5/<18.5kg/m²，n=9304，HF=880，调整后的危险比[aHR]1.389，95%置信区间[CI]1.3-1.485）或体重正常组（<18.5/≥18.5kg/m²，n=6024，HF=478，aHR 1.385，95%CI 1.266-1.515）发生 HF 的风险增加。在始终体重过轻组（<18.5/<18.5kg/m²，n=7674，HF=665，aHR 1.612，95%CI 1.493-1.740）中观察到最高的风险。
体重过轻与 DM 人群 HF 的风险显著相关。需要对体重过轻的 DM 人群进行 HF 的主动监测。
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